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	     <h1>网上预约挂号</h1>
		 <?php
				if($status=="form" || empty($status))
				{
			?>
		 <p class="wenben">请您详细、真实填写咨询内容与个人信息，以便我院导医人员与您尽快取得联系，您所填写的个人信息我们严格遵守保密原则。</p>
		 
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			<li id="youname">您的性别：</li><li><select id="sex" name="sex" style="float:left;"><option value="1">男</option><option value="2">女</option></select><p style=" float:left;">　性别可以作为分析病情的依据 </p></li>
			<li id="youname">您的年龄：</li><li><input id="age" name="age" type="text" class="shuruk" /><p style=" float:left;">　请填写您的真实姓名</p></li>
			<li id="youname">手机号码：</li><li><input id="telephone" name="telephone" type="text" class="shuruk1" /><p style=" float:left;">　根据手机号码来识别预约，必填项 </p></li>
			<li id="youname">预约项目：</li><li>
			
		

			<select id="type" name="type" onchange="typeChange();" style="float:left;"><option value="0" selected="selected">=请选择病种=</option><option value="3">男性不育</option><option value="4">女性不孕</option></select>



			<p style=" float:left;">　请填写您要预约的服务项目名称 </p></li>
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    value=0>=专家可不选=</option></select>
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				<?php
					}else if($status=="success")
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				?>
				<table width="250" border=0 align="center" cellpadding=0 cellspacing=0>
				  <tr><td height="30" style=" font-size:12px;">恭喜，在线预约已经成功提交。</td></tr>
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				    <td height="30" class="text" style=" font-size:12px;"><b>您的预约号是：<font color="#FF9900"><?php echo intval($id);?></font></b></td>
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				    <td height="30" style=" font-size:12px;">请您凭预约号  到长春天伦不孕不育医院挂号处挂号就诊。</td>
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		 <p class="wenben1"><font color="#FF9900" ><strong>友情提示：</strong></font>如有疑问，您可以：在线咨询或拨打电话咨询：400-668-0431（免费）、QQ:986700796。</p>
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